North Carolina asks CMS to revise Medicaid medical-frailty guidance
State officials say the federal guidance could make it harder for more than 64,000 people with cancer and other serious conditions to retain coverage.
RALEIGH — North Carolina officials are asking the federal government to revise new Medicaid guidance that they say could jeopardize health coverage for more than 64,000 residents with cancer and other serious illnesses.
Gov. Josh Stein and the North Carolina Department of Health and Human Services submitted public comments July 30 asking the Centers for Medicare & Medicaid Services to return to broader medical-frailty language associated with new Medicaid work requirements.
Federal law provides exemptions from those requirements for people with serious or complex medical conditions, disabling mental disorders, substance-use disorders and disabilities.
State officials contend that a subsequent CMS interim rule narrows the medical-frailty exemption by requiring beneficiaries to demonstrate that their conditions significantly impair their ability to work.
“The new federal guidance would upend that essential care and make it harder for some of the sickest Medicaid beneficiaries to keep their coverage,” Stein said in the state announcement.
Before the interim rule, North Carolina had been planning to use claims data and diagnosis codes to identify medically frail beneficiaries, according to the governor’s office. The state says the revised standard could require additional documentation from medical providers and more manual review by county eligibility workers.
North Carolina is one of nine states with a state-supervised but county-administered Medicaid eligibility system.
Melanie Bush, NCDHHS deputy secretary for Medicaid, said the narrower definition and added administrative requirements could cause eligible people to lose coverage.
The state estimates that more than 64,000 North Carolinians with cancer and other severe illnesses could be affected by the medical-frailty interpretation.
Officials said those potential losses would be in addition to an estimated 255,000 Medicaid expansion beneficiaries who could lose coverage because of other federal changes, including work requirements and twice-yearly eligibility reviews.
Nearly 740,000 people are enrolled through North Carolina’s Medicaid expansion program, according to the state announcement.
The comments ask CMS to permit states to rely on existing medical claims and diagnosis information when determining whether a person qualifies for the medical-frailty exemption.
Editor’s note: This article was drafted with the assistance of artificial intelligence and was reviewed and fact-checked by a member of the NC Political News editorial team before publication.
